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247 > Ch. 22, 23, 24 > Flashcards

Ch. 22, 23, 24 Flashcards

1
Q

Uterine atony

A

failure of uterus to contract and retract after birth

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2
Q

What is usually responsible for primary/immediate pPh?
What is the cause for late/delayed ppH?

A

Immediatae - uterine atony
Delayed- lacerations, uterine inversion, subinvolution, rupture

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3
Q

Degree of shock

Mild - 20%
Symptoms

A

Diaphoresis, increased cap refill, cool extremeities, maternal anxiety

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4
Q

Degree of shock

Moderate 20-40%
Symptoms

A

Tachycardia, postural hypotension, oliguria

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5
Q

Degree of shock

Severe >40%
Symptoms

A

Hypotension, agitation/confusion, hemodynamic instability

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6
Q

Typical signs of hemorrhage do not appear until as much as ____ml of blood has been lost

A

1800-2100ml

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7
Q

Why are the typical signs of hemorrhage not noticed earlier in pregnancy?

A

Maternal bv increases as much as 50%. Plasma volume increases
All of this provides a reserve for the blood lost during delivery

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8
Q

What are causes for PPH

A

Laceration, episiotomy, retained placental frag, uterine inversion, coag disorder, large baby, failure to progress during 2nd stage of labor, placenta accreta, induction with oxytocin, surgical birth, hematoma

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9
Q

Overdistension of uterus can be caused by what

A

Mutliple gestation, macrosomia, hydramnios, fetal abnormality, placenta previa, precipitous birth, retained placental frag. Prolonged or rapid forceful labor, bacterial toxins, anesthesia (halothane) mag sulf

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10
Q

Subinvolution

A

incomplete involution of uterus or failure to return to its normal size and condition after birth

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11
Q

Complications of subinvolution

A

hemorrhage, pelvic peritonitis, salpingitis, abscess formation

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12
Q

Causes of subinvolution

A

Retained placental frag, distended bladder, excessive maternal activity prohibiting proper recovery, uterine myoma, infection

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13
Q

Clinical picture of subinvolution
Treatment

A

pp fundal height that is higher than expected, boggy uterus, lochia fails to change color

stimulating uterus to expel frag with uterine stimulant and antibiotics

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14
Q

Uterine inversion

treatment

A

top of uterus collapses into inner cavity due to excessive fundal pressure or pulling on imbilical cord when placenta is still firmly attached to fundus

Treatment uterine relaxants, immediate manual replacement

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15
Q

Uterine rupture symptoms

A

pain, fetal heart rate abnormalities, vag bleeding

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16
Q

How does thrombosis prevent PPH after birth

A

by providing hemostasis. Fibrin deposits and clots in supplying vessels

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17
Q

What are abnormal coagulation studies

A

decreased platelet and fibringogen levels
increased prothrombin time
partial thromboplastin time
Fibrin defradtion productions and prolonged bleeding time

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18
Q

Thrombotic thrombocytopenic purpura
define
therapy

A

Autoimmune disorder of increased platelet destruction

**Glucocorticoids and caplacizumab = therapy

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19
Q

Von Willebrand Disease

Symptoms?

A

Prolonged bleeding time, deficiency of von willebrand factor and impairment of platelet adhesion

Signs - bleeding gums, easy brusing, menorrhagia, blood in urine/stools, nosebleeds, hematomas

*Von Willebrand factor increases in most women during preg. so not affected

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20
Q

Disseminated intravascular coagulation

A

acquired coagulopathy - clotting system is abnormally activated, resuling in widespread clot formation in small vessels throughout body which leads to depletion of platelets and coag factors

*not itself an illnes, always a secondary diagnosis

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21
Q

Clincal features of DIC

A

Petechiae, ecchymoses, bleeding gums, fever, hypotension, acidosis, hematoma, tachycardia, proteinuria, uncontrolled bleedind during birth, acute renal failure

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22
Q
A
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23
Q
A
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24
Q

Treatment goals for DIC

A

Maintain tissue perfusion through aggressive fluid therapy, oxygen, heparin, blood products

*treatment recommended for at least 2 weeks post birth

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25
Q

If PP bleeding continues even if there are no lacerations, nurse should suspect?

A

Retained placental fragments

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26
Q

What are symptoms of hematoma

A

Uterus is firm with bright red bleeding
Localized bulging area just underskin in perineal area
Severe pain and diff voiding
Hypotension, tachycardia and anemia

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27
Q

What do these findings suggest?
Gingival bleeding, petechiae, ecchymosis, venipuncture sites are oozing and prolonged bleeding. Lochia greater than normal

Increase in pulse and decrease in level of consciousness
Urinary output diminished

A

Coagulopathy

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28
Q

Contraindications for
PITCOIN

A

Never give undiluted as a bolus injection IV

Setup as a piggyback to ensure med can be discontinued promptly

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29
Q

Contraindications for
CYTOTEC
(mistoprostol)

A

Allergy, active cardiovascular disease, pulmonary or hepatic disease / caution in moms with ASTHMA

Never give undiluted as bolus injection IV

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30
Q

Contraindications for
PROSTIN E2 (dinoprostone)

A

active cardiac, pulmonary , renal or hepatic disease

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31
Q

Contraindications for
METHERGINE

A

Hypersensitive and hyertension

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32
Q

Contraindications for
HEMABATE (CARBOPROST)

A

ASTHMA due to bronchial spasm
active cardiovascular disease, pulmonary, renal or hepatic disease

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33
Q

Superficial venous thrombosis

A

usually involved saphenous venous system
confined to lower leg

*may be caused by use of lithotomy position

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34
Q

DVT
Involves what veins

A

deep veins from foot to calf, thighs, pelvis’
More common in left lower extremity

Calf swelling and tender, difference in circumference, erhthemia, warmth, pain with pressure, pedal edema

*can dislodge and migrate to lungs causing PE (unexplained SOB, severe chest pain)

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35
Q

Signs of PE

A

unexplained SOB, chest pain, tachypnea, tachycardia, fever, hypotension, syncope, distention of jugular vein, decreased o2, cardiac arrhythmias, hemoptysis, sudden change in mental status

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36
Q

What is treatment for mom with superficial venous thrombosis

A

NSAIDs
rest and elevation of affected leg
Warm compress
Antiembolism stockings

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37
Q

Parametritis

A

extension of endometritis, involves broad ligament and possbily ovaries/fallopian tubes

inflammation of pelvic floor

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38
Q

Septic pelvis thrombophlebitis

A

Infection speads along venous routes into pelvis

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39
Q

Postpartum infection / signs and symptoms

Endometritis

A

Lower ab tenderness or pain
Temp elevation
Foul smelling lochia
Anorexia
Nausea
Fatique
Leukocytosis and elevated sedimentation rate

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40
Q

Postpartum infection / signs and symptoms

Wound infection

A

Weeping serosanguineous or purulent drainage
Separation of edges
Edema
Erythema
tenderness
Discomfort
Maternal fever
Elevated WBC

41
Q

Postpartum infection / signs and symptoms

UTI

A

URgency
frequency
dysuria
flank pain
low grade fever
urinary retention
hematuria
urine positive for nitrates
cloudy urine with strong odor

42
Q

Postpartum infection / signs and symptoms

Mastitis

A

Flu-like symptoms
Tender, hot, red painful area on one breast
inflammation
cracking of skin around nipple
breast distention with milk

43
Q

Appropriate for gestational age (AGA)

A

newborn with weight that falls within the 10th to 90th percentile for gestational age

44
Q

Small for gestational age (SGA)

A

Newborns that weight less than 2500g (5lb8oz) at term
*below the 10th percentile

45
Q

Large for gestational age (LGA)

A

newborns whose birth weight is above 90th percentile, weighing more than 4000g (8lbs 13oz)

46
Q

(LBW) low birth weight
Very low birth weight
Extremely low birth weight

A

(LBW) low birth weight - 2500g (5.5lb)
Very low birth weight - less than 1500g (3lb5oz)
Extremely low birth weight- less than 1000g (2lb)

47
Q

Fetal growth restriction FGR

Also can be from?

A

pathologic counterpart of SGA
Rate of growth does not meet expected growth pattern
Placental insufficiency is principle cause of FGR

Can also result from aneuploidy, maternal malnutrition, htn, smoking, preE, chromosomal abnormalities, congenital malformations, infections

48
Q

Prolonged or sustained neonatal hypoglycemia can lead to

A

brain injury

49
Q

Polycythemia

Venous hematocrit above –%? and hemoglobin of more than –g?

-what happens? symptoms?

A

Venous hematocrit above 65% and hemoglobin of more than 20g

INcreased viscosity of blood assoc with symptoms of hypoperfusion / increased resistence to blood flow, decreased O2 delivery- can cause CNS dyfunction, hypoglucemia, decreased renal function, cardiorespiratory distress, coagulation disorders.

Clinical signs - respiratory distress, cyanosis, feeding diff, hypoglycemia, jitteriness, jaundice, ruddy skin color, seizures, lethargy

50
Q

How to support newborns with polycythemia

Asymptomatic
Symptomatic

A

Asymptomatic - fluids, close observations, repeat hemtocrit in 12 hours
Symptomatic - partial exchange transfusion w/ replacement of removed red blood cell with normal saline

51
Q

What are maternal factors that increase change of LGA newborn

A

DM, multiparity, prior history, postterm, obesity, gestational weight gain, male fetus, genetics

52
Q

SIgns of hypoglycemia in newborn

A

Lethargy, apathy, drowisness, irritability, tachypnea, weak cry, temp instability, jitteriness, seizure, apnea, bradycardia, cyanosis, pallor, feeable suck, poor feeding, hypotonia and coma

**may present with similar findings: septicemia, severe respiratory distress, congenital heart disease

53
Q

Hypoglycemia

A

below 35-45mg/dl

AAP recommends intervening for blood glucose less than 40 in 1st 4 hours of life and less than 45 at ages 4-24hrs

54
Q

How to treat hypoglycemia

Asymptomatic
Symptomatic

A

Asymptomatic - supervised feeding
Symptomatic- freq feeding, dextrose gel massaged into buccal mucosa. If persist, IV dextrose

55
Q

Treatment to
-Decrease blood viscosity
-lower hematocrit & blood viscosity
-hyperbilirubinemia

A

**Decrease blood viscosity **- increase fluid volume
lower hematocrit & blood viscosity - partial exchange transfusion
**hyperbilirubinemia **- hydration, early feedings, phototherapy

56
Q

Pre term
Late preterm
Full term
Post term

A

Pre term - before 37 wks
Late preterm - 34 0/7 - 36 6/7
Full term - 38-41wks
Post term - 42 wks +

57
Q

After 42 weeks placenta begins aging, what happens

A

Deposits of fibrin and calcium along with hemorrhagic infarcts occur and placental blood vessels begin to degenerate

Wasting occurs, loss of subQ and muscle

58
Q

Newborn respiratory system

Surfactant deficiency leads to
Unstable chest wall leads to
Immature respiratory control centers leads to
SMaller respiratory passages leads to
Inability to clear fluid from passages leads to

A

Surfactant deficiency leads to develop of respiratory distress syndrome
Unstable chest wall leads to atelectasis
Immature respiratory control centers leads to apnea
SMaller respiratory passages leads to increased risk for obstruction
Inability to clear fluid from passages leads to transient tachypnea

59
Q

What is it called when a newborn fails to establish adequate sustained respiration after birth

A

Asphyxia (perinatal acidosis)
_Depirvation of oxygen during birth process resulting in hypoxia that can lead to organ damage and death

60
Q

Equiptment for newborn resuscitation

A
  1. Wall vaccum suction
  2. Stethoscope
  3. pulse ox
  4. epinephrine
  5. volume expander
  6. IV fluids
  7. Wall or tank of 100% o2 w/ flow meter
  8. self inflating ventilation bag
  9. endotracheal tubes
  10. laryngoscopre
  11. ampules of naloxone w/ syringes
  12. wall clock
  13. disposable gloves
61
Q

large concentrations of 02 and sustained o2 sat higher than 95% while on supplemental ox have been assoc with

A

retinopathy of prematurity and further respiratory complications

*commone practice is to maintain o2 high 80s-mid 90s
*room air is perferred gas

62
Q

When newborn becomes chilled it attempts to conserve body heat by

A

vasoconstriction and thermogenesis by metabolizing brown adipose tissue and increasing o2 consumption

63
Q

What are symptoms of a newborn who is having problems with thermal regulation

A

Cool - cold touch
cyanotic
shallow or slow respirations
lethargic, hypotonic
feeds poorly
feeable cry
hypoglycemia

64
Q

Complications of hypothermia in newborn

A

Metabolic acidosis (secondary to anerobic metabolism used for heat production results in production of lactic acid)

Hypoglycemia

Pulmonary htn (secondary to pulmonary vasoconstriction)

65
Q

Signs of hyperthermia in newborn

A

tachycardia, tachypnea, apnea, warn to touch, flushed skin, lethargy, weak or absent cry, CSN depression

66
Q

What are different methods to admin newborn feedings

-Parenteral
-Enteral

Before34 weeks?
After 34 weeks?

A

Parenteral - through percutaneous central venous catheter delivery of TPN
Enteral - oral, continous nasogastric tube, or intermittent gavage tube feedings

After 34 wks - orally
Before 34 wks - parenteral

67
Q

What are some common indicators of pain in a newborn

A

facial expression, cry, withdrawl of body part, total body movment, physiological changes (o2 sat and rr)

68
Q

define asphyxia

A

impairment in gas exchange resulting in a decrease in blood oxygen levels (hypoxemia) and excess of carbon dioxide or hypercapnia that leads to acidosis

69
Q

What are risk factors to look for for hypoxic-ischemic encephalopathy?

A

Trauma from birth
Interuterine asphyxia
Sepsis
Malformation
Hypovolemic shock
Medication (hypnotics, excessive oxytocin, analgesics, narcotics)

70
Q

For newborn resuscitation, continue until what signs?

A

Pulse above 100bpm
good healthy cry
good breathing efforts
pink tounge (indicates good o2 supply to brain)

71
Q

AAP suggests stopping resuscitation if newborn exhibits no decetable heart rate after —-mins

A

10mins

72
Q

Reperfusion injury

A

when normal oxygenation and blood flow are restored too quickly - can cause inflammation

73
Q

What does surfactant do

A

forms a coating over the inner surface of alveoli, reducing surface tension and preventing alveolar collarpse at end of expiration

74
Q

What are the parameters assessed for the silverman-Anderson index?

A

Retractions of upper chest
Lower chest
Xiphoid
nasal flaring
expiratory grunt

0 - normal
1-moderate impairment
2- severe

75
Q

What treatment do you administer if a newborn has worsening hypoxemia and acidosis from meconium aspiration?

A

Hyperoxygenation to dilate pulmonary vasculature and close ductus arteriosis
OR
Nitric oxide inhalation to decrease pulm vasc resistance
OR
High freq oscillatory ventilation to increase chance of air trapping

In addition, admin vasopressor and pulm vasodilators along with surfactant

76
Q

Where is periventricular area

A

Rim of brain tissue that lines the outside of lateral ventricles

Contains rich network of capillaries that are extremely fragile and can rupture easily

77
Q

What will the lab tests ordered for Necrotizing Enterocolitis tell us

Kideny, ureter, bladder Xray
Ab XRAY
Blood values

A

Kideny, ureter, bladder Xray - confirms presence of pneumatosis intestinalis (air in bowel wall) and persistenly dialted loop of bowel
Ab XRAY - dilated bowel loops, abnormal gas patterns, air bubbles from bacteria adn thickened bowel walls
Blood values- metabolic acidosis, increased WBC, thrombocytopenia, neutropenia, electrolyte imbalance, DIC

78
Q

Infants of DM moms w/ vascular disease seldom develop RDS bc

A

the chronic stress of poor intrauterine perfusion leads to increased production of steroids which accelerates lung maturation

79
Q

What are the characteristics of a newborn to a DM mom

A

Puffy, rose cheeks
SHort neck
Buffalo hump
Massive shoulders
Distended upper ab
Excessive subQ fat

80
Q

How to prevent hypoglycemia with early feedings.. Benefits

A

provide early feedings (w/in 1 hr of birth)
feedings help to control glucose levels, reduce hematocrit adn promote bilirubin excrettion

81
Q

How to monitor blood glucose on a newborn? how often

A

heel stick q hour for first 4 hrs
then every 3-4 hrs until stable

82
Q

In a brachial plexus injury what reflexes are present/absent

A

present - grasp
Absent - moro, bicep and radial

83
Q

Cephalohematoma

A

Collection of blood secondary to rupture if vessels between skull and periosteum.
Appears w/in hours after birth

84
Q

Caput succedaneum

A

soft tissue swelling caused by edema of head against dilating cervix during birth

85
Q

Subarachnoid hem

A

may be due to hypoxis-ischemia, variations in BP, and pressure on head during labor

Bleeding of venous orign and contusions may also occur

86
Q

Subdural hem

A

(hemtomas)
tears of major veins overlying cerebral hemispheres or cerebellum. Increased pressure leads to tears

87
Q

Depressed skull fractures

A

may result from forceps, can also be spontaneous. causing subdural bleed, subarachnoid hem or brain trauma

88
Q

What 3 specific findings are a pattern of FAS

A
  1. Growth restriction
  2. carniofacial structural abnormalities
  3. CNS dysfunction
89
Q

What is the clinical picture of FAS

A

Microcephaly
Small eyelid fissures
abnormally small eyes
FGR
Maxillary hypoplasia
Thin upper lip
Short upturned nose
low birth weight
joint and limb defects
SGA
Congential cardiac defects
delayed fine and gross motor develop
poor eye-hand coord
mentally challanged
narrow forehead
Inadequate sucking and poor appetite

90
Q

Manifestations of Neonatal abstinence syndrom

CNS
METABOLIC, VASOMOTOR, RESPIRATORY
GI

A

CNS
Tremors, irritability
Seizures, hyperactive reflex, restlessness
Exaggerated moro., hypertonic, constant movment
high pitched excessive cry, disturbed sleep

Metabolic
Fever, freq yawning, mottling of skin, sweating, sneezing, nasal flaring, trachypnea 60+. apnea

GI
Poor feeding, frantick sucking, loose stools, projectile vomit

91
Q

What 3 mechanisms does bilirubin rise in newborns

A

Increased production RBC
Decreased removal (transient liver enzyme insufficency)
increased reabsorbtion (delay in bowels)

92
Q

What does physiologic jaundice result from

A

increased bili load bc of relative polycythemia, shortend RBC life span, immature hepatic uptake and conjugation process, increased enterohepatic circulation

*delayed passage of meconium are more likely to have

93
Q

Acute bilirubin encephalopathy

A

effects of hyperbili in first few weeks
can lead to death

Lethary, poor feeding, high pitched cry, poor tone, poor moro, incomplete flexion / as symptoms worsen = apnea, seizures, coma and death

94
Q

Chronic bili encephalopathy
aka Kernicterus

A

preventable neurologic syndrome resulting from deposition of unconjugated (indirect) bili in basal ganglia and brainstem nuclei

Movement disorder, auditory dysfunction, oculomotor impairment, dental enamel hypoplasia of deciduous teeth

95
Q

What are clinical manifestations of newborn Rh incompatibiltiy

A

ascites, anemia, CHF, edema, pallor, jaundice, hepatosplenomegaly, polyhydramnios, thick placenta, dialtion of umbilical vein

96
Q

What do the following test tell us

Direct Coombs test
Hemoglobin concentration
Total serum protein
Reticulocyte count

A

**Direct Coombs test **- id hemolytic disease (positive indicated sensitized)
Hemoglobin concentration - anemia
Total serum protein - Rh status and incompatibilty
Reticulocyte count - Id elevated level indicating increase hemolysis

97
Q

What are the signs of organ system dysfunction

Cardio compromise
Respiratory compromise
Renal compromise
Systemic compromise

A

Cardio compromise - tachycardia and hyptenson
Respiratory compromise - respiratory distress and tachypnea
Renal compromise - oliguria or anuria
Systemic compromise - abnormal values

98
Q

DIfference between gastroschisis and omphalocele

A

GASTROSCHISI- eviscerated bowel without peritoneal covering
OMPHALOCELE - eviscerated bowel with peritoneal covering

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